March 10, 2008

New Instructions for Medical Exams Conducted Outside the U.S.

The Centers for Disease Control (CDC) has issued changes in instructions for "panel physicians" conducting medical examinations abroad for immigrants to the U.S. in coordination with consular immigrant visa processing.

Changes in vaccination requirements for all applicants examined abroad include:

• Rotavirus vaccine, hepatitis A vaccine, meningococcal vaccine, human papillomavirus vaccine, and zoster vaccine have been added as age-appropriate to the vaccination requirements.
• Hepatitis B vaccine is required through 18 years of age.
• Influenza vaccine is required for children ages 6-59 months.
• Acellular pertussis-containing vaccines have been developed for persons ages 10-64 years.

Other significant changes to the immigration vaccination requirements include:

• Rotavirus vaccine should be given orally to children 2 through 6 months of age.
• Hepatitis A vaccine should be given to children 12 through 23 months of age.
• Meningococcal conjugate vaccine, specifically tetravalent meningococcal conjugate vaccine (MCV4) should be given to persons 11 through 18 years of age.
• Meningococcal polysaccharide vaccine (MPSV) or other forms of meningococcal conjugate vaccine (e.g., monovalent MCV) is an acceptable alternative if MCV4 is not available.
• Human papillomavirus vaccine should be given to females 11 through 26 years of age.
• Zoster vaccine should be given to persons 60 years of age or older.
• Hepatitis B vaccine should be given from birth through 18 years of age.
• Influenza vaccine should be given annually to children 6 through 59 months of age. It continues to be required for adults 50 years of age or older.
• Acellular pertussis-containing vaccines are available for use in persons at least 10 years of age. The adolescent and adult formulation of tetanus and diphtheria toxoid and acellular pertussis (Tdap) vaccine is given as a single (booster) dose for persons 10 through 64 years of age who have completed the recommended childhood diphtheria and tetanus toxoids and the pertussis/diphtheria and tetanus toxoids and acellular pertussis (DTP/DTaP) vaccine series.

Additionally, there are changes to Tuberculin skin tests (TST) for applicants <15 years of age in countries with a World Health Organization (WHO)-estimated tuberculosis incidence rate >20 per 100,000. The changes include:

• All applicants <15 years of age with TST =5 mm will be required to have a chest radiograph.
• Mycobacterial cultures for applicants with chest radiographs suggestive of tuberculosis disease.
• Treatment under a directly observed therapy (DOT) program.
• Completion of treatment prior to immigrating to the United States, according to American Thoracic Society/CDC/Infectious Diseases Society of America guidelines.
• New TB classifications for all applicants with suspected latent Mycobacterium tuberculosis infection and for contacts for cases of tuberculosis disease.

For details, see the CDC’s 2007 Technical Instructions for Vaccinations. Please note that the new instructions are specific to physicians outside of the U.S.