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News From the Centers for Disease Control and Prevention
July 9, 2008

Notice to Readers: Revised Technical Instructions for Tuberculosis Screening and Treatment for Panel Physicians

JAMA. 2008;300(2):164. doi:10.1001/jama.300.2.164

MMWR. 2008;57:292-293

CDC's Division of Global Migration and Quarantine (DGMQ) has released the 2007 Technical Instructions for Tuberculosis Screening and Treatment for Panel Physicians. These revised technical instructions and a list of the populations whose applicants for U.S. immigration are being screened in accordance with them are available at http://www.cdc.gov/ncidod/dq/panel_2007.htm.

CDC has U.S. regulatory authority over overseas medical examinations for immigrants, refugees, and asylees immigrating to the United States.* Panel physicians, who are appointed by the U.S. Department of State, perform overseas medical examination of applicants for U.S. immigration in accordance with technical instructions provided by DGMQ.

The previous technical instructions for tuberculosis screening have been in effect since 1991. Under the 1991 instructions, applicants aged ≥15 years are required to have a chest radiograph and provide three sputum smears for acid-fast microscopy if the chest radiograph is suggestive of active tuberculosis; however, no cultures (or drug-susceptibility testing) are required. Applicants who are sputum smear-positive must undergo treatment until they are smear-negative before traveling to the United States, but the 1991 requirements do not specify the therapy they should receive.1 In addition, the screening algorithms used for the 1991 instructions are insensitive and miss smear-negative, culture-positive cases2; the algorithms also are inadequate to prevent importation of multidrug-resistant tuberculosis into the United States.3