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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Ethics, Transparency, Support
~ What All Adoptions Deserve.
http://www.pear-now.org/

Adoptive Families Magazine "A TB Regulation Victory"

Adoptive Families magazine December 2009 issue, Adoptalk New and Notes section, article “A TB Regulation Victory” contains several misleading statements.


The article can be accessed here http://www.adoptivefamilies.com/news.php

Tuberculosis screening criteria and regulations are complex.

The statement “The regulations held adopted children to a higher standard than children born to American parents in another country, or even to tourists” has two flaws.

The first flaw implies that the 2007 TB screening guidelines to obtain an immigrant visa no longer differentiate between guidelines for children adopted internationally by US citizens and children screened in the US. The September 18 CDC updates are minor tweaks to practical screening steps for children aged two to ten years. The regulations still require screening that goes above and beyond screening for TB in children born in the US.

The second flaw is the implication that adopted children should not be held to a higher standard than children born to American parents. PEAR’s Position on Tuberculosis Management in International Adoptees, page 2 at http://tiny.cc/PEARTB describes why adoptees who have been in institutional care should be held to a higher standard. The excerpted passage:

“Children born to American citizens abroad are not and never have been in the same patient population as international adoptees. Differences in international adoptees include use of BCG vaccine, malnutrition, poor hygienic living conditions, institutional settings, being exposed to adult caregivers with TB, and being exposed in their communities to adults with TB and HIV. As a whole, children being adopted from these circumstances have a huge disparity of immune status compared to children born to American citizens abroad. Worse, this point deliberately misleads prospective parents away from the very real problem: the potential of foreign-born children residing in orphanages in high-prevalence TB countries having latent TB, active TB or MDR-TB, and the impact this will have not only on the child, but the adoptive family, and the community once the child has immigrated. “

The last paragraph of the article misleads the reader to believe that the waiver process used by the adoptive family was something unique or added after advocacy on September 18, 2009. It actually was built in to the original 2007 TB screening guidelines. PEAR’s Position on Tuberculosis Management in International Adoptees, page 2, describes the waiver process. The excerpted passage:

“The CDC guidelines include a Class A waiver for immigrants with active TB. This waiver allows the parent to opt to bring a child with active TB to the US as long as specific conditions are met. Conditions include a US doctor and state health officer signing the waiver to take responsibility for treatment of the child, the child reporting to the doctor or health facility upon arrival to the US for appropriate treatment, parental agreement to comply with the entire therapy, and parental acknowledgement of financial burden of treatment. The CDC technical instructions addendum that is dated September 18, 2009 includes further details of the Class A waiver system and electronic tracking to ensure complete TB treatment.”

We want to remind the public that that removing country of origin screening removes the safeguard to US citizens. In addition, such a policy shift would put the burden on the adoptive family to infer the necessity of the testing and subsequent cost of possible treatment, which was likely not a planned adoption expense.

The recently-completed survey by PEAR shows that only 37 percent of the 486 international adoptive parent respondents used an International Adoption Clinic or provider with international adoption expertise post-adoption. Only 57 percent of the adoptive parent respondents had their child tested with the Mantoux TB screening test post-adoption









Ethics, Transparency, Support
~ What All Adoptions Deserve.
http://www.pear-now.org/

Ethiopia Adoption Notice
U.S. DEPARTMENT OF STATE
Bureau of Consular Affairs
Office of Children’s Issues
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Adoption Processing at the U.S. Embassy in Addis Ababa

October 15, 2009


Taking into consideration recent allegations of misconduct in intercountry adoptions in Ethiopia the Department of State would like to remind adoptive parents that before an immigrant visa may be issued to an adopted child, a U.S. consular officer must ensure that the adoption is legal under Ethiopian law and that the child is qualified under U.S. immigration law to immigrate to the United States.

The Department of State reminds adoptive parents that consular officers are required by law to conduct an orphan investigation (I-604) to verify the child's orphan status prior to the issuance of an IR-3 or IR-4 immigrant visa. Depending on the circumstances of a case, this investigation may take up to several months to complete. Adoptive parents should therefore carefully consider whether to file their Form I-600 Petition to Classify an Orphan as an Immediate Relative at the USCIS district office closest to their place of residence in the U.S. or at Embassy Addis Ababa, and are urged to work with their adoption service provider to confirm the status of their case before traveling to Ethiopia.

Prospective adoptive parents and their adoption service providers should also be aware that on March 23, 2009 the U.S. Embassy began implementing the Centers for Disease Control’s (CDC’s) 2007 Tuberculosis Technical Instructions (TB TIs) for screening and treating tuberculosis for all immigrant visa applicants, including adopted children. 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, or obtain a waiver from the Department of Homeland Security (DHS), after review by the CDC, in order to travel to the U.S. An addendum to this new procedure was implemented on October 1, 2009 for all children under 10 years of age. You may obtain full information on the addendum by clicking on the following link: http://www.cdc.gov/ncidod/dq/panel-2007-addendum-ti-tb.html. For the vast majority of children, implementation of these new requirements will cause no significant delay in the processing of their cases.

Furthermore, children determined to have a Class A medical condition, such as HIV (as diagnosed by the Embassy’s designated panel physician), will be required to have an approved waiver from the DHS, United States Citizenship and Immigration Services (USCIS) before an immigrant visa can be issued.

All prospective adoptive parents are strongly urged to work with an adoption service provider instead of arranging a direct adoption through an orphanage or family member. The Embassy's Adoptions Unit can be reached at adoptionsaddis@state.gov.

Please continue to monitor http://adoption.state.gov/ for updated information as it becomes available.

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http://adoption.state.gov/news/ethiopia.htm

Ethics, Transparency, Support
~ What All Adoptions Deserve.
http://www.pear-now.org/

PEAR issues Position on Tuberculosis(TB) Management in International Adoptees

PEAR has issued a Position on Tuberculosis Management in International Adoptees due to the Centers for Disease Control and Prevention (CDC) rollout of TB screening for immigrants that now includes adoptees aged 2 to 14 from the high-TB-prevalence countries of Ethiopia, China and Haiti.

This position also addresses a summer petition issued by the Joint Council on International Children’s Services (JCICS) for waiving this TB screening requirement.

This is a complex medical issue that requires an understanding of TB itself, the increasing spread of all versions of TB across the world, and how adoptive parents in the US manage screening and treatment of all forms of TB. The PDF can be linked to on our website at http://www.pear-now.org/PEAR_Position_on_TB_Management.pdf


Ethics, Transparency, Support
~ What All Adoptions Deserve.
http://www.pear-now.org/