DOS Adoption Notice: India

Adoption Notice

U.S. DEPARTMENT OF STATE
Bureau of Consular Affairs
Office of Children’s Issues

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New Procedures for Identifying and Treating Active Tuberculosis


December 20, 2010

On October 1, 2010, the U.S. Embassy’s panel physicians in India began implementing the Center for Disease Control’s (CDC’s) 2007 Tuberculosis Technical Instructions which are required procedures for screening for all immigrant visa applicants, including adopted children. These include requirements that may impact the pace at which some adoption cases can be concluded. Adoptive parents should take note of the following information in their adoption planning.

For most children under 2 years of age, there will be no change in the testing procedure because no Tuberculin Skin Test (TST) is required. However, if the child shows signs of tubercolosis when examined by a panel physician the child will require the additional screening for tubercolosis that may take up to minimum of 8 weeks to complete. The Embassy’s panel pediatricians estimate that many children will show exposure for tubercolosis 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 requirements will cause no significant delay in the processing of their cases. Adoptive parents should consult with their adoption service provider if they have concerns.

• All children between 2-14 years of age require a new TST according to CDC specifications. This TST is currently available at:
  

Max Medcentre
N - 110, Panchsheel Park
New Delhi

• If the TST indicates the child has been exposed to tuburcolosis, then the child will need a chest x-ray to check for abnormalities. All children found to have abnormal chest x-rays will require a new screening procedure for tuburcolosis 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 applicants with chest x-ray findings suggestive of tuberculosis, or those who are suspected to have laryngeal tubercolosis, shall undergo three (3) sputum examinations. Sputum specimens will be collected at the designated laboratory:
  

SRL-Religare
GP-26, Maruti Industrial Estate
Udyog Vihar, Sector-18
Gurgaon, Haryana, India)

If the panel physician receives positive test results from the laboratory, the case will require drug susceptibility testing, and isolates will then be sent from SRL-Religare to:

Quest Diagnostics
A-17 Info City, Sector 32
Gurgaon, Haryana, India).

This new requirement will impose a delay of 45 to 60 days in the processing such cases.

• Children who have active tuberculosis will be required to submit to six months of Directly Observed Therapy (DOT) provided at the following clinic:
  

IOM in Max Medcentre
N - 110, Panchsheel Park
New Delhi

It is estimated that fewer than 10 orphans per year will require this treatment.

The CDC is phasing in these 2007 TB Technical Instructions worldwide in order to better identify and treat immigrant visa applicants with active TB. The requirements are not in effect in all countries at this time.

United States immigration law requires the medical examination for immigration purproses to be conducted only be approved panel physicians, prior to the issuance of an immigrant visa. It is the CDC’s responsibility to protect Americans from infectious diseases and the Embassy is required to follow all CDC guidelines. These 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. Panel physicians who conduct medical examinations are required to verify that immigrant visa applicants have met all of medical evaluation requirements.

For information the October 1, 2009 Technical Instructions for Tuberculosis Treatment and Screening, please refer to: http://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/tuberculosis-panel-technical-instructions.html.

For a list of Frequently Asked Questions regarding Tuberculosis Screening for International Adoptees, please refer to: http://www.cdc.gov/immigrantrefugeehealth/exams/adoptees-tuberculosis-screening-faq.html for detailed information.

http://adoption.state.gov/news/india.html

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