Tuberculosis

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	The applicant's name, contact information, IGRA and chest x-ray results must be reported to the local health department electronically through the California Reportable Disease Information Exchange (CalREDIE) Provider Portal. To sign up for the Provider Portal, submit a CalREDIE provider portal authorization form to tbc@ph.lacounty.gov.
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.

Tuberculosis Control Program