U.S. EMBASSY, ADDIS ABABA, ETHIOPIA
New Procedures for Identifying and Treating Active Tuberculosis
On March 23, 2009, the U.S. Embassy’s panel physicians began implementing the Center for Disease Control’s (CDC’s) new procedures for screening and treating tuberculosis (TB) for all immigrant visa applicants, including adopted children. These include new requirements that impact the pace at which some adoption cases can be concluded. Adoptive parents should take note of the following information in their adoption planning:
All children between 2-14 years of age require a new Tuberculin Skin Test (TST) according to CDC specifications. If the TST indicates the child has been exposed to TB, then the child will need a chest x-ray to check for abnormalities. This TST is currently available only at the clinic of the International Organization for Migration (IOM) in Addis Ababa. This new requirement will impose a very slight delay – perhaps one or two days – in the processing such cases.
All children found to have abnormal chest x-rays, will require a new screening procedure for TB that requires a minimum of 8 weeks to complete. Adoptive parents should be aware of this delay and factor it into their plans. Children whose x-rays are not abnormal will require no additional testing or delay.
All children who are HIV+, regardless of whether they test positive for exposure to TB or have abnormal chest x-rays, will be required to submit to the new screening procedure, which takes a minimum of 8 weeks to complete.
Children who are found to have active TB will be required to submit to six months of Directly Observed Therapy (DOT) provided at the clinic of IOM in Addis Ababa. It is estimated that fewer than 10 orphans per year will require this treatment.
For children under 2 years of age, there will be no change in the testing procedure (no TST is required). However, if the child shows signs of TB when examined by a panel physician, the child will require the new screening procedure for TB that requires a minimum of 8 weeks to complete.
The Embassy’s panel pediatricians believe that many children will show exposure for TB after the TST, but a very small number will show abnormal chest x-rays. If the child has a normal chest x-ray, no further testing is required.
For the vast majority of children, implementation of these new requirements will cause no significant delay in the processing of their cases.
Adoptive parents should consult with their agencies if they have concerns.
CDC is phasing in these new requirements worldwide in order to better identify and treat immigrant visa applicants with active TB. They are not in effect in all countries at this time.
CDC has conducted studies in other foreign countries and discovered that the previous method of identifying active TB failed to catch a large percentage of active TB cases. As a result, immigrants with active TB entered the U.S.
It is CDCs responsibility to protect Americans from infectious diseases. These new requirements will greatly improve the Embassy’s ability to identify visa applicants with active TB, and to ensure they receive the most effective treatment for their condition before they are granted visas.
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