New requirements of the Centers for Disease Control and Prevention (CDC) Division of Global Migration and Quarantine Tuberculosis
(TB) Technical
Instructions which went into effect October 1, 2018.
New technical instructions require the use of Interferon
Gamma Release Assay (IGRA) blood tests (either QuantiFERON or T-SPOT.TB Test),
instead of the TB Skin Test, for all applicants 2
years and older. During the status adjustment medical evaluation, an indeterminate test does not
need to be repeated and a chest x-ray does not need to be performed in order to
complete the I-693 form. A chest x-ray is needed for all applicants with a positive IGRA result.
Reporting to the local health department for TB
infection is now required once TB disease has been ruled
out.
For applicants who are diagnosed with LTBI, civil surgeons must:
- Inform such applicants that their LTBI diagnosis has been reported to the local health department.
- Advise the applicant that follow-up treatment is important to prevent TB disease.
- Complete and give the I-693 to the applicant - treatment is not required in order to continue the status
adjustment process.
For TB disease, applicants are given a designation on their I-693, however, the status adjustment process is
stalled until treatment has been completed.
Information for Civil Surgeons:
Required Civil Surgeon Reporting to local health
department:
Category |
Definition |
Reporting Requirements |
Latent TB Infection
(LTBI) |
Positive IGRA Normal Chest X-ray No known HIV
No signs / symptoms of active TB disease |
As of March 2024, all civil surgeons in the United States are required by the Centers for Disease Control and Prevention (CDC) to use an online system called eMedical to report persons adjusting their immigration status who are found to have latent TB infection (LTBI). Please use the eMedical system instead of CalREDIE for reporting LTBI
The California Department of Public Health has additional instructions for California Civil Surgeons on the California TB Controllers Association website: https://ctca.org/civil-surgeons/
The CDC has created tools/resources to help you use eMedical:
|
All HIV-infected
applicants |
History of HIV
infection |
If the applicant has
known HIV infection, an
IGRA and a chest x-ray
must be performed. HIV
infected applicants must
be referred to the
health department for
sputum testing. |
Active TB disease
(suspected or confirmed) |
Positive IGRA
Abnormal chest x-ray Extrapulmonary disease regardless of
chest x-ray results May or may not have signs / symptoms of active
TB disease |
Any confirmed or
suspected case of active
TB disease is required
by law to be reported
within one business day.
To report, complete the
Confidential Morbidity
Report (CMR) and submit
to the TB Control
Program by fax at (213)
749-0926, or by phone at
(213) 745-0800. |