The Department of Health and Human Services (HHS)/Centers for Disease Control (CDC) regulations require that all immigrants and refugees coming to the United States be screened for tuberculosis (TB). CDC’s Division of Global Migration and Quarantine (DGMQ) develops physician guidelines for TB testing and treatment of immigrants and refugees that are called Technical Instructions.

The TB Technical Instructions were updated in 2007 to use newer, more precise tests to reduce the chance of bringing TB into the United States and improve the health of immigrants and refugees through earlier diagnosis and updated methods of treatment. The 2007 TB guidelines make testing more precise by requiring cultures for immigrant applicants and refugees thought to have TB. Drug susceptibility testing (DST) on positive TB cultures was added to see which drugs would be likely to kill the type of TB found.

The 2007 TB Technical Instructions will be implemented in Uzbekistan on 1 Feb 2013.

Another update is the addition of directly observed therapy (DOT). Treatment must start before arrival in the United States and medical staff must observe patients in person as they swallow each dose of TB drug.

To help detect TB in children, the new TB TIs require that children aged 2 through 14 years undergo a TB skin test in countries where the TB rate is 20 cases or more per 100,000 population. If the skin test is positive, a chest X-ray is required. If the chest X-ray suggests TB, cultures and three sputum smears are required.

It is expected that an Immigrant Visa applicant who has a positive TB skin test and has then undergone further testing, with negative results, may be medically eligible to receive their visa is as few as 8 weeks. An applicant who requires directly observed therapy (DOT) may be medically eligible to receive their visa in as few as 6 months or as many as 24 months depending on the required duration of DOT.