FM SECSTATE WASHDC TO ALL DIPLOMATIC AND CONSULAR POSTS COLLECTIVE UNCLAS STATE 117586 E.O. 12958: N/A TAGS: CVIS, CMGT SUBJECT: CDC UPDATES TO MEDICAL EXAMINATION OF ALIENS

1. SUMMARY: On October 6, 2008, the U.S Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), published an Interim Final Rule (IFR) amending 42 CFR Part 34 - Medical Examination of Aliens. The IFR changed the definition of a communicable disease of public health significance, the scope of the medical examination for aliens, and the evaluation criteria for tuberculosis. The definition of communicable disease of public health significance continues to include the previous list of eight specific diseases (including HIV infection) and adds two new disease categories: (1) quarantinable diseases designated by Presidential Executive Order; and (2) diseases that meet the criteria of a public health emergency of international concern, which require notification to the World Heath Organization (WHO) under the revised International Health Regulations (IHR) of 2005. The scope of the medical examination for aliens has been amended to incorporate a more flexible, risk- based approach based on medical and epidemiologic factors.

2. The definition of "communicable disease of public health significance" in 42 CFR 34.2(b) continues to include a list of the following eight specific diseases:

(1) Chancroid;

(2) Gonorrhea;

(3) Granuloma inguinale;

(4) Human immunodeficiency virus (HIV) infection;

(5) Leprosy, infectious;

(6) Lymphogranuloma venereum;

(7) Syphilis, infectious stage;

(8) Tuberculosis, active;

3. In addition to this list, two new disease categories have been added to allow flexibility in rapidly responding to unanticipated emerging or re-emerging outbreaks of disease. These categories are: (1) Quarantinable diseases designated by Presidential Executive Order; and, (2) Diseases that meet the criteria of a public health emergency of international concern, which require notification to the World Health Organization (WHO) under the revised International Health Regulations (IHR) of 2005.

4. The scope of the overseas medical examination has been revised to include a risk-based approach for the two new disease categories listed above. Under this new approach, HHS/CDC may require aliens to undergo additional screening, testing, and treatment as needed for the diseases in the two new categories. The riskbased approach allows HHS/CDC to use medical and epidemiological factors to determine if additional screening, testing, and treatment are needed for a specific population within a specific geographic location where the risk is high. The overseas medical examination will continue to consist of a medical history, physical examination, and screening/diagnostic testing. HHS/CDC will provide information directly topanel physicians when new or additional screening, testing, and treatment protocols for the communicable diseases of public health significance are issued. HHS/CDC will also provide information and guidance to affected posts. Panel physicians should not screen for any of the new communicable diseases of public health significance without specific notification from HHS/CDC. 5. The addendum to the Technical Instructions (TIs) for Medical Examination of Aliens addressing the new communicable diseases of public health significance is available on CDC's website: http://www.cdc.gov/ncidod/dq/technical.htm. As indicated in the addendum to the TIs, panel physicians should not screen for any of the new communicable diseases of public health significance without specific CDC UPDATES TO MEDICAL EXAMINATION OF ALIENS Page 1 of 2 http://travel.state.gov/visa/laws/telegrams/telegrams_4388.html?css=print 11/25/2008 notification from HHS/CDC.