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Tuberculosis technical instructions for civil surgeons

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  • Corporate Authors:
    National Center for Emerging and Zoonotic Infectious Diseases (U.S.). Division of Global Migration and Quarantine.
  • Description:
    The medical screening for tuberculosis among people applying for adjustment of status for US permanent residence, hereafter referred to as applicants, is an essential component of the medical evaluation. Because tuberculosis is a challenging disease to diagnose, treat, and control, these instructions are designed to enable civil surgeons to detect applicants who need further evaluation for pulmonary tuberculosis disease, ensure that those diagnosed are treated, and thus reduce the risk of spread of tuberculosis among the US population.

    Pulmonary tuberculosis is a disease that involves the lung parenchyma and is often infectious (i.e., contagious [determined by sputum smear examination for acid-fast bacilli (AFB) and mycobacterial culture]). Laryngeal tuberculosis is rare but highly infectious. Disease of the lung parenchyma may occur concurrently with pleural tuberculosis, and the parenchymal lung disease may not be apparent on chest radiograph because of compression of affected lung tissue by pleural fluid. Because the emphasis for the status adjustment medical evaluation is on infectiousness, for the purpose of this document, the term tuberculosis disease refers to disease of the lung parenchyma, pleural tuberculosis, laryngeal tuberculosis, and tuberculosis of the intrathoracic lymph nodes. Other forms of extrapulmonary tuberculosis and latent tuberculosis infection (LTBI) are not included in the definition of tuberculosis disease for the purposes of these Technical Instructions, and are defined separately.

    The Division of Global Migration and Quarantine (DGMQ) developed these instructions in consultation with US tuberculosis subject matter experts. These instructions define the specific responsibilities of civil surgeons in terms of testing and referral for purposes of US lawful permanent residence eligibility only. These instructions are specific to the status adjustment medical evaluation and must not be used as guidelines to test for or treat tuberculosis disease in other settings or as a clinical manual that defines detailed laboratory procedures or specific treatment regimen details.

    US Citizenship and Immigration Services in the US Department of Homeland Security (DHS) designates civil surgeons. Civil surgeons must perform the medical examination according to the procedures prescribed in these Technical Instructions. Civil surgeons must report all confirmed or suspected tuberculosis disease cases promptly to the health department of jurisdiction to ensure that applicants are started on the appropriate drug regimens and that thorough contact or source case (for pediatric applicants) investigations are initiated.

    The instructions in this document supersede all previous Tuberculosis Technical Instructions, Updates to the Technical Instructions, memoranda and letters to civil surgeons. These instructions are to be followed for tuberculosis disease screening and treatment of all applicants.

    CS287106-A

    TB-civil-tech-instructions.pdf

  • Content Notes:
    Overview of Tuberculosis Technical Instructions -- Tuberculosis Screening -- Medical History -- Physical Exam -- Immune Response to M. tuberculosis Antigens -- Chest Radiography -- Required Referral and Reporting to Health Departments -- Tuberculosis Laboratory Testing by the Health Department -- Tuberculosis Treatment -- Tuberculosis Classifications -- Re-classification of Applicants after Treatment for Tuberculosis Disease -- Waivers -- Glossary of Abbreviations -- Definitions of Selected Terms.
  • Subjects:
  • Document Type:
    Pamphlet (or booklet)
  • Collection(s):
  • Main Document Checksum:
    urn:sha256:91b38150c429fe909c195c02f6e02f83b8fe70ba16b68c12acf9073bd100fad8
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  • File Type:
    Filetype[PDF - 30.87 MB ]
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