CDC History of Tuberculosis Control - Medical and Public Health ...

DOTS-plus, the WHO strategy for the
management of MDR TB treatment in lowresource
settings, in this oblast. In addition,
DTBE has been involved in the establishment
of a center of excellence for MDR TB in
Latvia, which was formerly part of the Soviet
Union and which has a successful DOTS
program, but nonetheless has one of the
highest levels of MDR TB in the world.
Finally, an MDR TB training course run by
DTBE in collaboration with National Jewish
Medical Center was conducted overseas this
past year in Estonia for participants from
Russia and the Baltics.
The Role of CDC’s Division of Quarantine
in the Fight Against TB in the US
by Paul Tribble
Public Health Advisor, DQ
The Division of Quarantine (DQ), the oldest
organization in the United States Public
Health Service, has had a rich and colorful
history and plays an important role in the
nation’s fight against tuberculosis (TB),
especially with respect to immigrants and
refugees. DQ, which was established by the
National Quarantine Act of 1878, was
transferred to the Centers for Disease Control
Immigrants of the past awaiting medical clearance
(CDC) in 1967. DQ has had several previous
titles, including the Division of Foreign
Quarantine and Quarantine Division, and is
continuing to evolve with another proposed
name: the Division of Global Migration and
Quarantine.
TB Control at the Millennium
68
United States (US) immigration law mandates
an overseas health assessment for immigrants
and refugees, with the intent of denying
admission to persons with certain diseases of
public health significance, physical or mental
disorders associated with harmful behavior,
drug abuse or addiction, or likelihood of
becoming a ward of the state. The conditions,
the requirements as to who must be screened,
and the examination and tests to be performed
are prescribed by the Secretary of the
Department of Health and Human Services,
with oversight by DQ.
The current list of communicable diseases of
public health significance that are considered
“inadmissible” are infectious TB, syphilis,
lepromatous Hansen’s disease, HIV infection,
and certain sexually transmitted diseases
(STDs). The overseas health assessment,
which is valid for 12 months, is carried out by
local physicians known as “panel physicians,”
who are appointed by the US embassy or
consulate. In some cases, clinics or hospitals
are designated as panel physicians in countries
where large numbers of immigrants originate
(e.g., Mexico, the Philippines, and Viet Nam).
Panel physicians are provided with a booklet
of technical instructions concerning the
assessment process which, in addition to the
TB evaluation, consists of a medical history,
physical examination, and screening for
physical and mental disorders, substance
abuse, STDs, Hansen’s disease, and HIV
infection.
Panel physicians make their own
arrangements for the required radiologic and
laboratory tests. Currently, no countries have
on-site supervision beyond the local consular
officer, except Viet Nam, which has a CDC
microbiologist consultant. Panel physicians
do, however, receive periodic visits by CDC
physicians and microbiologists based in
Atlanta. Panel physicians are paid for their
services by immigrant applicants on the basis
of a fee scale set locally. In the case of refugees,
the US Department of State reimburses the